Elsevier

Anaerobe

Volume 48, December 2017, Pages 165-171
Anaerobe

Review article
Clinical microbiology
Spontaneous C. septicum gas gangrene: A literature review

https://doi.org/10.1016/j.anaerobe.2017.07.008Get rights and content

Highlights

  • This article summarizes the pathophysiology, clinical spectrum, diagnosis and management of spontaneous C. septicum infections.

  • A systematic review and analysis is performed for published spontaneous C. septicum gas gangrene cases since 1956 to 2016.

  • Reviewed data suggests that a known or occult malignancy was present in 71% cases.

  • Pathophysiology of spontaneous C. septicum infection is discussed and gaps in the current understanding are identified

Abstract

As the infectious disease paradigm undergoes a subtle shift, unusual infections associated with malignancy and immunosuppression are being increasingly reported. Spontaneous or non-traumatic Clostridium septicum infection is one such unusual infection which has gained prominence. This article aims to understand the pathophysiology, clinical manifestations and current trends in diagnosing and treating this rare but deadly infection. To understand the multifactorial causation of this infection a review of published cases of spontaneous C. septicum gas gangrene was performed and a total of 94 such cases were identified. Several factors were analyzed for each case: age, infection location and underlying illness, presenting signs and symptoms, neutropenia, gross pathology of the colon, antibiotic use, surgical intervention, and survival. A known or occult malignancy was present in 71% patients and an overall mortality of 67% was observed.

Section snippets

Introduction, background, microbiology

Gas gangrene, or clostridial myonecrosis, which invariably evokes images of the battlefield and warfare, is a necrotizing infection of muscle caused by anaerobic bacteria, namely C. perfringens, C. novyi and C. septicum; although other pathogenic clostridial species are also known to cause this devastating disease. The source of infection is most commonly an infected wound resulting from a deep penetrating or crushing injury, which provides an anaerobic milieu for growth of bacteria [1]. With

Pathogenesis of spontaneous C. septicum infection

C. septicum is an opportunistic pathogen in humans. It usually gains access through the gastrointestinal tract from a site of mucosal defect. Bacterial swarming is a multicellular behavior which involves differentiation of cells into hyperflagellated swarm cells, which are capable of undergoing rapid and coordinated movements across solid and viscous surfaces. It is common among flagellated bacteria, including Salmonella, Vibrio, Yersinia, Serratia, and Proteus and C. septicum. In vitro studies

Clinical spectrum of spontaneous C. septicum infection

The clinical spectrum of spontaneous C. septicum is variable and can present as skin and soft tissue infection, abscess, neutropenic enterocolitis, or sepsis [22]. In a 1989 review of 162 cases by Kornbluth, 81% of patients with C. septicum infection were found to have an associated malignancy, 34% with colorectal carcinoma, and 40% with a hematological malignancy [6]. Skin and soft tissue infection ranging from cellulitis to life threatening gas gangrene constitute the most common

Diagnosis and management

The diagnosis and management of spontaneous C. septicum gas gangrene pose serious challenges due to various factors: patients at extremes of age, nonspecific symptoms, coexisting illness and rapid fulminating course with signs and symptoms of shock within hours of presentation. Diagnosis is mainly clinical though radiological findings of gas in affected area can suggest gas gangrene. A gram stain from the wound tissue or aspirate from bullae shows numerous large gram positive bacilli [4].

Review of C. septicum spontaneous gas gangrene literature

C. septicum is not a normal human inhabitant and disease occurrence is related to certain host factors which either increase the colonization rates and invasiveness of the bacteria in gastrointestinal tract or cause an enhanced susceptibility to the infection, or both. To identify these risk factors, the authors did a PubMed search for all the published cases using the keywords ‘clostridium septicum,’ ‘gas gangrene,‘ and ‘clostridial myonecrosis’ and identified 94 cases of spontaneous gas

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    This material is based upon work supported in part by the U.S. Department of Veterans Affairs, Office of Research and Development Biomedical Laboratory Research Program.

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